What anatomic factors predispose to pediatric gastroesophageal reflux?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Anatomic factors that predispose to gastroesophageal reflux include the following:

  • The angle of His (made by the esophagus and the axis of the stomach) is obtuse in newborns but decreases as infants develop; this ensures a more effective barrier against gastroesophageal reflux

  • The presence of a hiatal hernia may displace the lower esophageal sphincter (LES) into the thoracic cavity, where the lower intrathoracic pressure may facilitate gastroesophageal reflux; however, the presence of a hiatal hernia by itself does not predict gastroesophageal reflux, which means that many patients who have a hiatal hernia do not have gastroesophageal reflux

  • Resistance to gastric outflow raises intragastric pressure and leads to reflux and vomiting; examples include gastroparesis, gastric outlet obstruction, and pyloric stenosis


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